Manager II, Credentialing - BioPlus Specialty Pharmacy at Anthem (Elevance)

Anticipated End Date:

2026-05-12

Position Title:

• Manager II, Credentialing
• Bio Plus Specialty Pharmacy

Job Description: Manager II, Credentialing

Bio Plus Specialty Pharmacy Hybrid:

This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

Bio Plus Specialty Pharmacy is a proud member of the Elevance Health family of companies. Bio Plus offer consumers and providers an unparalleled level of service that’s easy and focused on whole health. Through our distinct clinical expertise, digital capabilities, and broad access to specialty medications across a wide range of conditions, we deliver an elevated experience, affordability, and personalized support throughout the consumer’s treatment journey.

The Manager II, Credentialing - Bio Plus Specialty Pharmacy develops, implements and controls the credentialing process for all in-house professional provider consultants and all contracted providers within the region. Provides guidance regarding policies, procedures and regulatory requirements.

How you will make an impact:

• Ensures that all legal, licensure and accreditation standards are met.
• Reviews the approval and termination of professional provider contracts as they relate to the credentialing process.
• Ensures the accurate and timely information for the purposes of re-credentialing, data analysis and directory generation as well as recommending changes to the credentialing criteria and processes.
• Monitors all governmental and private agency initiatives in the credentialing area.
• Ensures all credentialing and re-credentialing policies and processes are in compliance with NCQA and all applicable state regulations.
• Assures credentialing activities are integrated within the appropriate QI committees and departments.
• Hires, trains, coaches, counsels and evaluates performance of direct reports.

Minimum Requirements:

Requires a BA/BS degree in Business Administration, Health Science, medical records or related field and a minimum of 3 years management and credentialing experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Managed care experience and MBA or MHA degree strongly preferred.
• People leadership experience strongly preferred.

Job Level:

Manager

Workshift: Job Family:

PND > Credentialing & Licensing

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

NOTE:

Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.